November 14, 2005 Board Meeting Minutes

BOARD MEETING
PUBLIC SESSION MINUTES

November 14, 2005

Hilton Burbank Airport & Convention Center
2500 Hollywood Way
Burbank CA 91505
(818) 843-6000

CALL TO ORDER

The Public Session meeting was called to order at 8:20 a.m. by President Renner.Members in attendance proceeded with conducting business as a "Committee," as a quorum was not present.

LEGAL COUNSEL REASSIGNMENT

President Renner announced the Board's new legal representation and introduced Ms. LaVonne Powell.

LAW AND PROFESSIONAL ETHICS COURSE
(Barbara M. Stenson, RCP)

Provider Presentations and Consideration for Approval

Ray Hernandez, Education Committee Chair, California Society for Respiratory Care (CSRC):
President Renner introduced Ray Hernandez, Education Committee Chair, CSRC. Mr. Hernandez thanked the Board for giving the CSRC the opportunity to present its course and he introduced his colleagues Janyth Bolden, CSRC President and Ms. Dale Alexander. Mr. Hernandez proceeded with the presentation and entertained questions and comments from the Board.

Upon Mr. Svonkin's arrival, a quorum was established. President Renner recalled the public session at 9:10 a.m. and the Board proceeded to conduct its business.

APPROVAL OF MARCH 25, 2005 PUBLIC SESSION MINUTES

Dr. Sheldon moved to approve the March 25, 2005 Public Session Minutes as written.

M/Sheldon/S/Stern
Unanimous: Renner, Sheldon, Stenson, Stern, Svonkin
MOTION PASSED

EXECUTIVE OFFICER'S REPORT
(Stephanie Nunez)

2005 NBRC Annual Meeting: Report

Ms. Molina advised the Board that she attended the NBRC's annual State Licensure Liaison Meeting in September and provided an update regarding items covered at the meeting.

Upcoming Conference Attendance/Presentations

Ms. Nunez identified three upcoming conferences that the Board may find beneficial and choose to have staff participate.

Information regarding the conferences are as follows:

1. November 18, 2005 National Organization for Competency Assurance Long Beach, CA
2. February 3-5, 2006 Federal of Associations of Regulatory Boards San Diego, CA
3. March 21-23, 2006 MedTrade Spring Conference & Exposition Las Vegas, NV

Mr. Svonkin expressed his concern and stated that the Board should be very selective due to budget expenses.

Ms. Nunez stated that CAMPS has offered to pay all expenses, should she attend the MedTrade conference.

Dr. Sheldon stated that he supports staff's attendance if expenses are within our budget. He added that the second and third conferences sound very important to the RCB.

Discussion ensued.

Dr. Sheldon moved that Ms. Nunez attend the three conferences and follow-up with a report to the Board.

M/Sheldon/S/Stenson
Unanimous: Renner, Sheldon, Stenson, Stern, Svonkin
MOTION PASSED

Unlicensed Personnel Reviews Relating to Polysomnography, Pulmonary Function Testing, Hyperbaric Oxygen Therapy, and Home Care:
Update and Consideration to Establish Special Task Force

Ms. Nunez stated that she and President Renner met with the Sunset Review Committee to discuss the Board's recommendations as they relate to the unlicensed practices of polysomnography, pulmonary function testing, hyperbaric oxygen therapy and home care. Ms. Nunez and President Renner informed the Sunset Review Committee that the Board wanted to present these issues to determine whether or not they should be addressed prior to Sunset Review.

Ms. Nunez requested that the Board create a special task force, consisting of two board members, to meet with legislative staff to further discuss possible legislation.

Mr. Stern moved to create task force as requested by Ms. Nunez.

Ayes: Renner, Sheldon, Stenson, Stern
Nays: Svonkin
MOTION PASSED

Mr. Svonkin asked Ms. Nunez how often various reports distributed to the Board are produced. Ms. Nunez stated that it depends on the type of report, but noted that most reports are prepared and provided at board meetings. Mr. Svonkin then asked if reports could be provided to members on a quarterly basis. Ms. Nunez stated that this would not be a problem and she suggested that the quarterly reports replace reports provided in agendas.

With no objections given, Ms. Nunez ensured this process would be implemented next year.

Provider Presentations and Consideration for Approval

Bill Dubbs, Director of Education & Management, American Association for Respiratory Care (AARC):
On behalf of the AARC, Mr. Dubbs thanked the Board for allowing him the opportunity to participate in the development of an ethics course.

Mr. Dubbs proceeded with the presentation and entertained questions and comments from the Board.

President Renner and Ms. Stenson thanked both the CSRC and the AARC for their diligence in creating the courses and providing informative presentations.

Mr. Svonkin moved to approve 75% as the universal pass rate.

M/Svonkin/S/Stern
Unanimous: Renner, Sheldon, Stenson, Stern, Svonkin
MOTION PASSED

Dr. Sheldon asked at what point he should recuse himself since he was co-chair of the AARC's Ethics Committee and co-author of its course.

Ms. Powell explained that it would be appropriate for Dr. Sheldon to recuse himself. However, she added that without his vote the Board would not have a quorum.

Mr. Stern moved to reconsider the minimum threshold.

M/Stern/S/Stenson
Ayes: Renner, Stenson, Stern
Nays: Svonkin
Abstained: Sheldon
MOTION PASSED

Mr. Stern moved that the pass rate be no less than 70%.

Discussion ensued.

Mr. Svonkin stated that the pass rate should be 75% as he believes that a higher threshold is needed.

President Renner explained that this is a new process and supports setting the pass rate at 70%. He added that the issue of increasing the pass rate may be revisited at a later date.

Ayes: Renner, Stenson, Stern
Nays: Svonkin
Abstained: Sheldon
MOTION PASSED

President Renner entertained a motion to determine the time frame allowed for the course exam.

Mr. Stern moved for an open ended exam, so long as it is completed in one sitting.

M/Stern/S/Renner
Ayes: Renner, Stenson, Stern, Svonkin
Abstained: Sheldon
MOTION PASSED

The Board also made the following recommendations to the CSRC and AARC:

• Procedures be in place to address Americans with Disabilities Act (ADA) requests;
• Participants be allowed one (1) year to complete the course/exam after enrollment;
• The post examination be scored on all cumulative components, not by each section; and
• There be no wait time to retake the post examination if previously failed.

President Renner moved that the Board make its decision regarding final approval of the courses contingent upon the AARC and CSRC providing the Board with any additional information and by working in conjunction with Ms. Stenson with regards to implementation.

M/Renner/S/Svonkin
Ayes: Renner, Stenson, Stern, Svonkin
Abstained: Sheldon
MOTION PASSED

Mr. Svonkin moved to have the ethics exams implemented January 1, 2006 with final approval delegated to the Education Committee.

M/Svonkin/S/Stern
Ayes: Renner, Stenson, Stern, Svonkin
Abstained: Sheldon
MOTION PASSED

Proposed Implementation Dates

Mr. Svonkin moved to approve the proposal with course completion required by licensees beginning with January 31, 2008 expiration dates.

M/Svonkin/S/Stern
Ayes: Renner, Stenson, Stern, Svonkin
Abstained: Sheldon
MOTION PASSED

Consideration to Waive Course for Applicants

Dr. Sheldon spoke with several respiratory care program directors who consider their ethics course to be quite relative to the average accreditation for their schools. These program directors want to know if allowances can be made for graduates who have already taken some form of an "ethics" course as part of their program.

Ms. Powell explained that the law reads ". . . professional course offered by the Board, the AARC, or the CSRC prior to initial licensure." She further stated that the Board promulgated a regulation that states, "every applicant shall successfully complete a course in law and professional ethics as provided in section 1399.352.7 of this division, prior to initial licensure."

Discussion ensued.

Marlyn Haberwood, Program Director, Concorde Career Institute: Ms. Haberwood stated that the respiratory program offered at Concorde Career Institute teaches ethics but the course is not as detailed as what the CSRC and the AARC presented. She added that she would like to incorporate these as part of their ethics program.

Dr. Sheldon stated that this was a reasonable alternative that can be suggested to the various programs.

The Board convened into Closed Session at 10:40 a.m.. The Public Session reconvened at 10:48 a.m..

EXECUTIVE COMMITTEE REPORT
(Larry L. Renner, RCP, President)

Kim Cooper Salinger, MBA, RRT, Service Recognition

President Renner reported that Kim Cooper Salinger recently resigned from the Board to focus on her family. He added that while serving, Ms. Salinger always provided insight and valuable input and will be missed.

Ms. Nunez added that a plaque and letter of appreciation had been prepared for Ms. Salinger, and would be mailed to her.

Sunset Review Extension

President Renner stated that SB 232 was recently signed by the Governor and extends our sunset date from July 2007 to July 2008. He added that the Board's Sunset Review Report will be due September 1, 2006.

Application Process for Persons Displaced by Hurricane Katrina

President Renner informed the Board that modifications were made for individuals who were displaced as a result of Hurricane Katrina. He applauded staff for making our Board the first to offer licensure assistance, via the website for those considering relocation to California.

Ms. Nunez stated that, to date, the Board's received five applications and another five inquiries. She asked the Board how it would like to continue licensure modification for those affected by Hurricane Katrina.

Mr. Svonkin requested that a process/policy be in place for future disasters, and added that he has concerns with waiving background checks.

Dr. Sheldon stated that "disaster" should be defined. In addition, he feels that this does not apply to those not licensed in another state.

Mr. Stern stated that he does not feel that such a process/policy needs to be implemented and feels that what the Board has in place is acceptable, considering that Hurricane Katrina was a very rare incident.

Mr. Svonkin disagreed and added that the Board should have procedures in place to handle various situations which California may encounter.

Dr. Sheldon suggested that this be researched and further discussed at a future meeting.

Fiscal Review

Ms. Nunez presented the fiscal review information and entertained questions and/or comments from the Board.

Due to Mr. Svonkin's departure at 11:00 a.m., the Board no longer had a quorum and was, therefore, required to conduct business as a Committee.

LEGISLATIVE/LEGAL AFFAIRS COMMITTEE REPORT
(Gary N. Stern, Esq., Chair; Scott J. Svonkin, Member)

2005 Legislation

Mr. Stern summarized the 2005 legislation and entertained questions and/or comments from the Board.

2006 Proposed Legislation

Mr. Stern summarized the 2006 proposed legislation which includes new language regarding: (I) Subpoenas; (2) Cite/Fine Appeals - Costs; (3) Licensee - Probationary License; and (4) Updates regarding Unlicensed Personnel Reviews.

Discussion ensued.

Ms. Nunez suggested that authority be given to the Legislative Committee to work with the Board's legal counsel in developing actual language for the proposals. In addition, she suggested that the Unlicensed Personnel Reviews be assigned to the task force, established earlier in the day, that will be working with the Sunset Committee.

Dr. Sheldon moved to give authority to the Legislative Committee to work with the Board's legal counsel in determining actual language for items 1, 2, and 3 and to assign item 4 to the task force.

M/Sheldon/S/Stern
Unanimous: Renner, Sheldon, Stenson, Stern
MOTION PASSED AS A COMMITTEE

ENFORCEMENT COMMITTEE REPORT
(Gopal Chaturvedi, Chair; Gary N Stern, Esq., Member)

Enforcement Statistics

Mr. Stern entertained questions and/or comments from the Board regarding the Enforcement Statistics.

Ms. Nunez informed the Board that the number of cases referred to the Office of the Attorney General has reduced significantly due to the implementation of the Board's cite & fine program.

Proposed Regulatory Language: Unlicensed Personnel, Citation and Fine

Ms. Nunez explained that this language had been approved previously, but because of many factors, the Board decided to wait to move forward until it had completed its unlicensed personnel reviews. She added that a Supervising Deputy Attorney General reviewed the language last month, as well. Ms. Nunez requested approval to move forward with the regulations, stating that the purpose of this is to cite & fine those individuals practicing respiratory care, who are not licensed by the Board.

Mr. Stern moved that the Board move forward with the regulation.

M/Stern/S/Sheldon
Unanimous: Renner, Sheldon, Stenson, Stern
MOTION PASSED AS A COMMITTEE

PROFESSIONAL LICENSING COMMITTEE REPORT
(Larry L. Renner, RCP, Chair; Richard L. Sheldon, MD, Member)

Board of Vocational Nursing and Psychiatric Technicians Correspondence

Ms. Nunez provided an update regarding recent correspondence received by the Board of Vocational Nursing and Psychiatric Technicians (BVNPT).

September 29, 2005 Correspondence: "Adjustment of Ventilator Settings by Licensed Vocational Nurses" Policy Rescinded:

In response to a number of phone calls received by the Board, Ms. Nunez stated that the BVNPT was asked to review a policy it released in the late 1990's. According to the phone calls received, LVNs are being asked to manage and monitor ventilator patients, raising very serious patient-safety concerns.

Ms. Nunez stated that she attended the BVNPT's September 16th board meeting where the policy was rescinded. However, the BVNPT has indicated that it may attempt to promulgate regulations in the future, should it find that LVNs are needed to perform these skills to ensure safety for stable or chronic ventilator-dependent patients in long-term care settings, such as skilled nursing facilities, rehabilitation centers, home health and similar non-acute settings.

September 30, 2005 Correspondence: Scope of Practice Letters Posted on Website/APA Compliance & Shortage of Respiratory Care Practitioners

The BVNPT has requested that the Board review its practice of posting scope of practice responses on its website. Ms. Nunez stated that the Board's previous legal counsel, George Ritter, has indicated that the Board is operating within the law when posting this information. Ms. Nunez suggested that she and President Renner be allowed to respond to the BVNPT and explain that the Board is within its legal rights to post scope of practice information. Ms. Nunez also noted the BVNPT's concern with long-term care patients and the paucity of RCPs.

Ms. Nunez asked if the Board would be interested in contracting with a California State University to conduct a workforce study, as has previously been done for the Board of Registered Nursing. The one-time expense for this service is roughly estimated to cost between $65,000 to $70,000.

Dr. Sheldon stated that he would be in favor of obtaining research information that would provide the Board with clear data.

Dr. Sheldon moved that the Board proceed with the research study.

M/Sheldon/S/Stern
Unanimous: Renner, Sheldon, Stenson, Stern
MOTION PASSED AS A COMMITTEE

Drug Compounding

Dr. Sheldon expressed concern regarding the potential risk to patients related to the compounding of respiratory drugs and moved that the Board of Pharmacy be invited to attend an upcoming board meeting to discuss/explain:

1. 1. Status of compounding;
2. 2. Detail cases regarding compounding;
3. 3.Current position; and
4. 4.Future plans

M/Sheldon/S/Stenson

Ms. Powell suggested that if the Board of Pharmacy is unable to attend an upcoming Board meeting, that an informal meeting be held between Ms. Nunez and a Member with a representative from the Board of Pharmacy.

Dr. Sheldon withdrew his motion and requested that Ms. Nunez contact the Board of Pharmacy to invite a representative to an upcoming meeting, or to schedule a meeting with a representative to discuss the four concerns previously mentioned.

CRT/RRT vs. Licensed RCP Statistics

Ms. Nunez reported that effective January 1, 2005, the National Board for Respiratory Care (NBRC) implemented a three-year limit on the length of time an individual may remain eligible for the RRT examination following graduation from an accredited/advanced respiratory care program.

Around that time, Dr. Sheldon suggested that staff begin tracking the effects of the time limit on our licensees. Ms. Nunez added that from November 2004 to October 2005 the increase in the number of licensees who also possess a CRT and/or RRT credential was very small.

ELECTION OF OFFICERS

This item was deferred as there was no quorum.

SCHEDULING OF 2006 MEETINGS

The Board tentatively scheduled the following dates and locations for its 2006 Board meetings:

1. February 10, 2006 Sacramento
2. April 14, 2006 Burbank
3. June 9, 2006 San Jose
4. August 11, 2006 San Diego
5. November 17, 2006 Sacramento

FUTURE AGENDA ITEMS

None were received at this time

PUBLIC COMMENTS ON ITEMS NOT ON THE AGENDA

Jeffrey Espinoza, Chair, Advanced Practice Commission, CSRC: Mr. Espinoza thanked the Board for allowing him to speak and extended an invitation for the Board to visit his hospital, Riverside County Regional Medical Center.

Mr. Espinoza distributed a letter addressed to the Board regarding the CSRC's concerns with the minimum requirements needed to be licensed in California. He explained that the Advanced Practice Commission was appointed to advocate improvements towards patient safety and respiratory care practitioner effectiveness/competency in addition to increasing professionalism and opportunity by advocating that (1) the RRT credential become the minimum credential required to practice respiratory care in the State of California, (2) initiate and explore the feasibility of working towards the establishment of an advance practice credential and license for RCPs who wish to advance their career in critical care sciences and practice, and (3) represent the CSRC as the liaison to the Board for the above initiatives and interest as approved by the CSRC Board of Directors. Mr. Espinoza further stated that the Advance Practice Commission and the CSRC believe what they have proposed is absolutely necessary.

Ms. Janyth Bolden, CSRC President: In response to Mr. Espinoza's comments, Ms. Bolden stated that the CRT tests for minimum standards and requirements but that therapists with this credential regularly perform on critical care patients although they have not provided an expectation of competency and do not necessarily possess the skills to adequately perform many functions.

Dr. Sheldon commented that this suggestion be taken very seriously.

Ms. Nunez suggested that this issue be discussed during the Strategic Planning Session.

Dr. Sheldon moved that this item be placed on a future meeting agenda.

M/Sheldon/S/Stern
Unanimous: Renner, Sheldon, Stenson, Stern
MOTION PASSED AS A COMMITTEE

STRATEGIC PLANNING SESSION

Travis McCann, Training and Development Unit, Department of Consumer Affairs introduced himself to the Board and the public and explained his role as facilitator in the Strategic Planning Session. He added that the purpose of the Strategic Planning Session was to re-define the focus of the Board, to prepare for changes in future goals due to the dynamics in the profession, and to review and revise the Board's current Strategic Plan as needed.

The following identifies those portions of the Draft Strategic Plan where changes were made.

The Board agreed to change its Mission Statement as follows:

"The Respiratory Care Board of California's mission is to protect and serve the consumer by enforcing the Respiratory Care Practice Act and its regulations, expanding the delivery and availability of services, increasing public awareness of respiratory care as a profession, and supporting the development and education of all respiratory care practitioners."

The Board's Vision will continue to read:

"All California consumers are aware of the respiratory care profession and its licensing board, its mission and mandate, and that every person treated by a respiratory care practitioner in California receives the most competent and qualified care available in the world."

The Board further developed and modified its Strategic Plan and thanked Mr. McCann for his assistance.

A revised version of the Strategic Plan will be presented to the Board for approval at its next meeting.

PROPOSED EXPENDITURES

This item was deferred as there was no quorum.

ADJOURNMENT

President Renner adjourned Public Session at 4:00 p.m.